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Ask most oral surgeons and they’ll tell you that you’re better off safe than sorry when it comes
to wisdom teeth.

Have them out early and your risk for long-term problems including infections and decay are low,
they say. If you wait and do encounter problems, removal will carry more risks.

In recent years, though, there has been some debate about the wisdom of removing wisdom teeth
where there is no pressing dental concern.

A research review published during the summer by the Cochrane Collaboration concluded that there
was no evidence to support or refute routine removal of teeth that aren’t causing symptoms. They
did not find a single well-designed study that compared quality of life for those who’d had
symptom-free teeth removed with those who’d kept them.

The international network reviews research on various medical topics to advise health-care
providers, policymakers and patients about health care.

The American Association of Oral and Maxillofacial Surgeons released a study two years ago that
said 8 in 10 young adults who kept their wisdom teeth had problems within seven years, and that
monitoring the teeth over a lifetime might be more expensive than taking them out early.

Most of us have wisdom teeth, or third molars. Some people have one or two, others have eight.
Four is most common. In some cases, they come in just fine if there’s room.

But they often don’t break the gum line or are only partially exposed, which dentists refer to
as “impacted.”

There is general agreement that they should be removed if they cause pain or other problems,
including decay of those teeth and adjacent teeth, gum and bone disease, and cysts.

But, “Sometimes we’ll see a tooth that’s in the wrong position and none of those things are
occurring. Then you get into the decision-making process,” said oral surgeon Dr. Douglas Anderson,
who practices Downtown.

Nobody argues that all impacted wisdom teeth will cause problems. But surgeons say that the
longer you wait into adulthood, the riskier surgery becomes should difficulties arise.

“Ideally, you should ask your dentist if he or she foresees any problems with your wisdom teeth
and if you should be evaluated by a surgeon,” said Dr. Richard Scheetz Jr., an oral surgeon who
practices at Dublin’s Oral and Facial Surgeons of Ohio.

The best time for that is in your mid- to late-teens, he said. At that point, most of us are
healthy and our wisdom teeth haven’t developed fully, making them easier to remove, Scheetz said.
The complication rate is about 5 percent in that population, compared with as high as 50 percent in
people in their 30s and 40s, he said.

The most common complication is “dry socket,” which occurs when the blood clot at the site of
the extraction is dislodged or has dissolved before the wound has healed. That exposes the
underlying bone and nerves and results in severe pain.

More serious risks, which become more common with age, include nerve and blood-vessel damage. As
with any surgery, wisdom-tooth removal does carry the very rare risk of death.

It’s hard to know which young patients will have problems with their wisdom teeth, Scheetz
said.

Those who have wisdom teeth buried under bone and no symptoms at age 25 are probably better off
leaving them there and having them monitored, he said.

Anderson said he, too, usually recommends watching patients who have higher surgery-complication
risks.

It’s not uncommon for those who eventually have a problem to have it in only one wisdom tooth,
he said. Those patients often opt to just have that tooth removed.

Wondering why we have these troublesome teeth in the first place?

“As human brains are getting larger and faces are becoming smaller, the jaw bones are becoming
smaller,” Scheetz said. “Unfortunately, we’re still producing the same number of teeth.”